出血を主徴とする小腸非腫瘍性病変の診断と治療─出血を主な臨床像とするCrohn病

Small Intestinal Hemorrhage due to Crohn's Disease

要旨●Crohn病の腸管合併症として出血があり，まれに大出血を来す．診断には，CTや内視鏡，血管造影が行われるが，複数箇所からのものやびまん性出血が多く，出血点の特定は困難なことも少なくない．治療はまず絶食，補液による保存的治療を行う．抗TNFα抗体は速やかな止血に有効である．大量出血には，内視鏡治療や血管塞栓術を行う．多くは保存的治療で止血される．薬物治療に反応せず，内視鏡や血管造影で止血できない場合は，手術が行われるが切除範囲は最小限にする．また，再出血が少なくないので十分な内科治療により再発リスクを下げる．Crohn病による小腸出血は少ないが，適切な対策をとり，低侵襲に治療していく必要がある．

　Bleeding is an intestinal complication of Crohn's disease, although life-threatening bleeding rarely occurs. For diagnosis, CT, endoscopy, and angiography are commonly performed. However, bleeding points is often multiple or diffuse, and specific bleeding points are often difficult to be located. First, the patients are fasting and given infusion. Anti-TNF α antibody is effective for rapid hemostasis. Endoscopic treatment and vascular embolization are performed for massive bleeding. Bleeding is stopped with conservative treatment in many cases. If bleeding cannot be stopped by conservative treatment, surgery is performed ; however, the range of resection should be minimal. To avoid re-hemorrhages, sufficient medical treatment is necessary. Small bowel bleeding due to Crohn's disease is not common, but it needs appropriate diagnosis and minimally invasive treatment.